ESP block during surgery in an infant with coagulation disorders: a case report

The article presents a clinical case of combined anesthesia during surgery on abdominal organs with an analgesic component provided by an ESP block with 0.2% ropivacaine solution on both sides in a two-month-old child with coagulation disorders. Choosing the optimal method of anesthesia for children in need of surgery is one of the most pressing medical problems. After conducting numerous studies, it was concluded that the use of regional analgesia in the context of multimodal anesthesia is a safe and effective method for perioperative anesthesia in newborns and infants. Epidural anesthesia is often used, which refers to neuroaxial blocks and, despite its advantages, has a number of contraindications, as well as may be accompanied by rare but significant complications. In this regard, peripheral blocks have been increasingly resorted to recently. The article demonstrates the possibility of effective use of the ESP block as an alternative to epidural anesthesia in a child who arrived at the hospital from the region at the age of 2 months and 3 days of life with liver failure and impaired hemostasis, which was confirmed in laboratory blood tests. Immediately after birth, the patient needed respiratory support for 29 days of life. The child was admitted to the hospital for further examination, clarification of the diagnosis and further treatment. After conducting a number of additional studies, it was decided that surgical intervention in the amount of liver biopsy and cholecystocholangiography was necessary. The presence of hemostasis disorders in blood parameters was a contraindication for the use of epidural anesthesia, therefore, in order to reduce the risks of ventilation support and enteral nutrition in the early postoperative period, it was decided to use the ESP block, which belongs to peripheral blocks and is performed using ultrasound navigation and has no absolute contraindications to hemostasis. Thus, in the postoperative period, high-quality multimodal anesthesia was achieved without the use of opioids, artificial ventilation was not required, and early initiation of enteral nutrition was implemented. The presented clinical case demonstrates the possibility of using the ESP block as an alternative to epidural anesthesia as part of combined anesthesia in children in the first months of life during abdominal surgery. The use of peripheral blockades is not limited by the presence of hypocoagulation. The risk of bleeding with the ESP unit is minimal, given the technical simplicity and ultrasound navigation. This method can become a reliable component of multimodal anesthesia in children starting from the newborn period.